Is Preventing Childhood Obesity Affordable?

This may seem like a stupid question – of course, many readers will probably agree, that we need to prevent and better manage childhood obesity, no matter what it costs.

But in the end, someone still has to pay the bills, and so knowing what it may cost, is not an unreasonable question to ask.

The problem, however, is that economic forecasts are highly dependent on all kinds of assumptions and the perspective of what costs count, depends on who is looking – a narrow ‘health-care’ cost perspective is very different from a broader societal perspective of lost income, reduced productivity, and the substantial emotional cost of obesity (much of which has little to do with obesity itself but rather results from the pain caused by the societal bias and discrimination that kids and adults with excess weight have to endure).

Nevertheless, even with a very narrow perspective through the lens of people who pay for health care, these kind of analyses can be enlightening.

Therefore, it is with interest that I read the paper by Sai Ma and Kevin Frick from the Johns Hopkins Bloomberg School of Public Health, published in the latest issue of Academic Pediatrics.

As the authors point out:

“To endorse interventions at the earliest ages, one needs to understand 3 critical details: 1) the persistence of childhood obesity into adulthood, 2) the degree to which interventions are likely to be adopted by the children and their families at different stages in children’s lives, and 3) the potential returns on investment.”

So this study attempts to project at what level of effectiveness and cost a population-based or targeted intervention for childhood obesity would yield a positive net economic benefit.

The analyses is based on data from the National Health and Nutrition Examination Survey, the persistence of obesity from childhood to adulthood from a literature review, and a cost estimate from the 2006 Medical Expenditures Panel Survey.

Simulations were conducted to estimate the break-even point for interventions that take place between ages 0 and 6 years, ages 7 and 12 years, and ages 13 to 18 years, with a range of effectiveness.

The simulations show that, from a pure medical cost perspective, spending approximately $1.4 to $1.7 billion at present value for each birth cohort will break even if 1 percentage point reduction in obesity among children is achieved.

If this 1 percentage point in obesity rates is achieved through population-based interventions, they would break even between $280 and $339 per child at present value.

In contrast, If this 1 percentage point reduction is achieved solely by targeting obese children, one could afford to spend up to $1648 to $2735 per obese child.

In addition, the authors note that:

“…although for population-based interventions, per capita breakeven point for every percentage point reduction is about the same in each age group, to reach 1 percentage point reduction requires a higher effectiveness level of the intervention in the younger age group. For example, for every 2 percentage point reduction in obesity, a 55% effectiveness level is needed among the 0- to 6-years age group, 20% effectiveness level is needed for those aged 7 to 12 years, and approximately 17% is needed for those aged 13 to 18 years. This implies that interventions need to be more effective for younger children than those targeting older children in order to achieve the same economic returns.

The high cost savings of targeted interventions and needed higher effectiveness of interventions for children aged 0 to 6 years implies that providing targeted approaches perhaps makes more economic sense than providing population-based interventions.”

In support to favouring targeted interventions for younger kids, the authors discuss that:

“Limited research has found engaging parents is one single important effective factor among early interventions, which again requires intensive and customized interventions. Additionally, empirical evidence suggests preventions targeting high-risk children, such as children with obese parents or from disadvantaged backgrounds, could achieve better results than those offering service to the whole population of children.

In contrast, a population-based approach could be more applicable for older adolescents because they have a much higher obesity rate (18%), and there are problems such as stigma and feasibility imbedded in targeted interventions.”

As the authors also discuss, these estimates need to be taken with a grain (or rather a teaspoon) of salt, as we do not really know what health problems will actually develop in today’s kids with overweight and obesity (they may well end up far healthier than we think). Also, we don’t really know how health care costs will increase in the future.

Perhaps, even more importantly, while the authors tell us how much one could ‘afford’ to spend on these measures, they also note that data showing that any such interventions would actually work are rather limited – indeed, I am not aware of any strategies that have actually shown sustainable population-level reductions in 1 percentage point in obesity prevalence.

So even if policy makers did make this money available for addressing childhood obesity, it is not readily apparent on what specific interventions (population-wide or targeted) this money would actually be best spent to achieve this result.

In my patients, I always worry about balancing the potential risk of doing nothing against the potential risk of doing the wrong thing.

At a population level such risk-benefit analyses are even more daunting. As with all complex problems, wrong policy decisions (no matter how well-intended), that result in ‘unintended consequences’ (e.g. increasing weight-bias, reinforcing obesity stereotypes, promoting unhealthy weight-obsessions or dieting behaviours, etc.), could potentially harm far more people than they help.

All cost discussions aside, perhaps improving the health of the population by making it easier for all kids and adults to eat healthier, increase their physical fitness, and feel good about themselves (no matter what their weight), may not only reap greater health benefits but also turn out to be far more affordable and feasible than focusing too narrowly on simply reducing obesity percentage points.

Let us save the obesity treatments for the folks, who really need them.

AMS
Toronto, Ontario

Ma S, & Frick KD (2011). A simulation of affordability and effectiveness of childhood obesity interventions. Academic pediatrics, 11 (4), 342-50 PMID: 21764018